Attorney at Law

Personhood and Separation

The following is the next installment in a series of posts which began with the piece, Half Guilty.

At the end of last year, media outlets around the world lit up with news of the birth of conjoined twins in Brazil. The boys, Jesus and Emanuel, exhibit dicephalic parapagus conjoining, the same union as Americans Brittany and Abigail Hensel. They differ in that the share only one set of vital organs. Doctors credit the Hensel twins’ dual set of organs with their success into adulthood. Questions of separation, as always, abound.

Whenever conjoined twins come along, it’s interesting to note how journalist and doctors comment on their individuality. A few examples below:

“A Brazilian baby was born with two heads, named Jesus and Emanuel, but appears to be in good health, according to doctors.” — International Business Times

“Despite all the problems we have as a small interior hospital we managed to save both mother and baby, which was our aim.” — Hospital director Claudionor Assis de Vasconcelos

“They are being monitored by specialists to see how they develop.” — BBC News

In the first two quotes, the commentator refers to the twins in the singular. In the latter quote the writer uses the plural pronoun “they” to signify their duplicative personhood.

The teratologist Saint-Hilaire noted that conjoined twins were given separate names, indicating their individuality, as springing from the practice of baptizing children on their heads. A body with well-formed two heads was therefore baptized once on each head and each received a name.

As science and medicine evolved, so did our longevity. While most conjoined twins would die in infancy 100 years ago, with the advent of modern medicine and an appreciable understanding of conjoinment (Chang and Eng Bunker could have been easily separated), conjoined twins can survive well past infancy and into adulthood. This allows us to appreciate the separate personalities that conjoined twins take on as the grow older, giving credence to the argument that there are in fact two individuals present in one entangled body.

One could argue then that under this logic a person exhibiting multiple personality disorder should be granted personhood for every personality in their brain. Regardless of the fact that multiple personality disorder lacks the physical component of conjoinment, the difference lies in the fact that multiple personality disorder, at least in theory, is curable.

Simultaneously with the news of Jesus and Emmanuel’s births came the news of the possibility of separation. “A lot of work is needed, in terms of scans and tests, before doctors will know if they can separate them or not, and just how organs and blood vessels are shared and linked. It takes quite a while before they can decide how feasible [separation] is.” — Patrick O’Brien, a spokesman for the UK’s Royal College of Obstetrician and Gynaecologists. Later, doctors would reveal that separating the twins is not an option because they share a set of organs. Attempting to separate them would be to kill one if not both of them (see Jodie and Mary).

Days before the birth of Jesus and Emmanuel, Chilean conjoined twins Maria Paz and Maria Jose (pictured above) made their way into the news. When the girls were 10-months old, doctors assessed their conjoinment and determined that separation was feasible. The 20-hour surgery took place and doctors deemed it a success. A week later on December 18, 2011, the news dropped: “A 10-month-old girl who was surgically separated from her conjoined twin died Sunday after suffering general organ failure, said the director of a Chilean children’s hospital.”

Despite all the science, all the innovation, and all the careful planning, their success became a failure with the death of one of the twins. They “were so preoccupied with whether they could that they didn’t stop to think if they should.” Alice Dreger is a bio-ethicist who continues to ask the question: should we separate conjoined twins? When conjoined twins come along, doctors’ first instinct is to wonder if they can be separated to give them a better chance at a “normal life.”

The thinking goes that we want people to be able to live the most normal life possible and conjoinment stands inapposite to that goal. But Dreger rebuts this assertion; perhaps conjoinment is what’s normal for them. For all the risk and possible little reward (rendering one as less than the Platonic ideal, reducing mobility in both twins, risking death), why does science encourage dangerous separation procedures? Instead, why not reconsider normal and accept that perhaps their conjoinment, their entanglement is the norm for these twins. If they can live full lives together, why are we so eager to rip them apart?

For Jesus and Emmanuel, separation is not an option. But the fact that doctors talk in terms of separation indicates that there is more than one person contained in these conjoined twins’ body, for it always takes two to tango.